Yale Journal of Health Policy, Law, and Ethics

Current Issue: Volume 22, Issue 2

The Ethics of Legalizing Non-Voluntary Euthanasia

Jonas-Sébastien Beaudry and Anne-Isabelle Cloutier

This Article serves as a critical introduction to the ethics and law of non-voluntary euthanasia (NVE). It begins by describing the current state of the law and potential arguments to render non-competent patients eligible for NVE. It then surveys the main ethical arguments in favor of and against NVE along four clusters of considerations: suffering, life, vulnerability and justice. This Article also addresses issues that have received less attention within mainstream debates on the topic, namely, policy considerations related to the social dimensions of vulnerability, challenges to moral personhood, and practical barriers to determining the competence of certain patients.

Housing is Health: Prioritizing Health Justice and Equity in the U.S. Eviction System

Emily Benfer

The public health field has long recognized the association between housing and health. In one of the most poignant examples of housing as a social determinant of health, the COVID-19 pandemic amplified the link between an individual’s housing instability and community-wide health. “Housing is health” became the justification for halting the eviction system: Policymakers nationwide adopted moratoria, eviction protections, emergency rental assistance, and other housing supports with the goal of protecting community-wide health. These robust measures resulted in unprecedented low eviction filing rates and extensive benefits to individual and public health. Today, with the lapse of pandemic interventions, the eviction crisis is reemerging as a pervasive threat to public health. Eviction filing rates have returned to or surpassed historical averages in jurisdictions across the United States. Policymakers across the country are called to address the eviction system as an urgent public health priority.

This Article applies the World Health Organization Conceptual Social Determinants of Health model and the Health Justice Framework to the United States eviction system to demonstrate how it operates a structural determinant of health inequity that severely harms historically marginalized groups. Eviction disproportionately affects Black renters, who are filed against at more than five times the rate of white renters. Overwhelmingly, Black women and families with young children are evicted at the highest rates. In a typical year, 7.6 million people —40 of whom are children—live in households that receive one or more eviction filing and are at risk of housing loss. For all of these people, interaction with the ostensibly neutral eviction system is associated with severe and lasting health harms across the life course. This Article extensively documents the public health and social science evidence demonstrating that housing is health and linking eviction to negative health outcomes. It provides evidence-based examples of structural determinants in the eviction system—including court processes, laws, policies, and landlord management and screening practices—that comprise the scaffolding of health inequity. Finally, this Article offers a model for achieving health equity and housing stability through the application of the Health Justice Framework to the U.S. eviction system.

Aggregating Liability for Medical Malpractice

Omer Pelled

Some injurers, such as large medical facilities, are involved in many accidents, even when they act reasonably. Under prevailing law, these injurers are liable only for the harm they cause by failing to take reasonable care. To reach a finding of liability, courts must review every incident to determine whether the injurer was negligent and, if so, whether the negligent conduct was the but-for cause of the injury. However, it is often easier and more accurate to determine whether an injurer negligently caused unreasonable harm to some (unknown) victims, based on outcomes, than to examine the injurer’s conduct in each incident. For example, suppose a court determines that it is reasonable for 100 patients to contract an infection during hospitalization. In that case, it can surmise that when 150 patients have contracted an infection, the hospital or its employees negligently caused harm to 50 patients. In light of this informational advantage, this article examines an aggregated liability regime that, like a strict liability regime, depends solely on outcomes. However, this aggregated regime requires the injurer to pay only for harm that could reasonably have been avoided, like under a negligence regime. This article shows that when applied to medical facilities, the proposed regime increases the chances that negligent hospitals will compensate victims while significantly decreasing the direct and indirect costs of investigating suspected malpractice cases individually. Last, the article shows that aggregated liability can be applied to other tortfeasors, such as polluting factories and product manufacturers, and that it offers significant advantages when applied to manufacturers of smart devices and other AI products.